Healthcare Provider Details

I. General information

NPI: 1841305877
Provider Name (Legal Business Name): SAINT MARY OF NAZARETH HOSPITAL - CHICAGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W DIVISION ST
CHICAGO IL
60622-8151
US

IV. Provider business mailing address

2233 W DIVISION ST
CHICAGO IL
60622-8151
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-3444
  • Fax: 312-770-3541
Mailing address:
  • Phone: 312-770-3444
  • Fax: 312-770-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054.019887
License Number StateIL

VIII. Authorized Official

Name: CHRISTOPHER DOAN
Title or Position: MANAGING ASSOCIATE GENERAL COUNSEL
Credential:
Phone: 909-235-4307